Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Donna Lagman. LPA observed 5 residents (R1-R5), 3 staff (S1, S2, S3) in the facility. Licensee Cindy Song Chen (LCN) also came to the facility.

LPA toured the facility inside and out with ADM. License, Administrator Certificate, and personal rights posters were observed in the facility. LPA reviewed 3 resident file and 3 staff files.

Family room, kitchen, dining room, 2 restrooms, a office area, a staff live-in room, 5 resident rooms, and garage were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet was observed locked. Knives closet, and dish washing soap closet were observed locked. Room temperature was at 74 degree F, and hot water temperature was at 114 degree F in facility. Fire extinguisher was serviced on 12/20/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detectors were tested, and were working. First aid box, and flash lights were observed in the facility. There are 4 bed with bed rail. ADM provided the documents for the 4 residents to use bed rail.

Front yard and backyard were inspected. 3 storage rooms were observed at backyard. The fence of the backyard were observed old. LCN stated the facility will upgrade the fence within one month. The last time the facility conducted the emergency and fire drill was on 5/5/2025.

Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.